Provider Demographics
NPI:1326531799
Name:MATTHEWS, KAITLYN (CRNA)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 MOUNT HOPE RD
Mailing Address - Street 2:
Mailing Address - City:WHARTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07885-2816
Mailing Address - Country:US
Mailing Address - Phone:724-554-0020
Mailing Address - Fax:
Practice Address - Street 1:1 DIAMOND HILL RD FL 3
Practice Address - Street 2:
Practice Address - City:BERKELEY HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07922-2104
Practice Address - Country:US
Practice Address - Phone:908-277-8872
Practice Address - Fax:908-464-4930
Is Sole Proprietor?:No
Enumeration Date:2018-06-11
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR17968900163W00000X
NJ26NJ00839300367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse